Provider Demographics
NPI:1720071277
Name:PARK, SONNY YONG (MD)
Entity type:Individual
Prefix:DR
First Name:SONNY
Middle Name:YONG
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1988 KINGS GATE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8191
Mailing Address - Country:US
Mailing Address - Phone:864-640-0395
Mailing Address - Fax:
Practice Address - Street 1:1988 KINGS GATE LN
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8191
Practice Address - Country:US
Practice Address - Phone:864-640-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078315A207P00000X
WI1987320207P00000X
NJ25MA10015400207Q00000X
MEMD22311207Q00000X
SC25559207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ33329OtherSTATE MEDICAL LICENSE